Vaginal birth after previous two or more caesarean sections: a systematic review

Vaginal birth after caesarean section (VBAC) is an appropriate solution to decrease the caesarean section rates and also to minimise the morbidities and complications due to repeat caesarean sections. Though trial for vaginal birth, that too after two or more caesarean sections is challenging, it will certainly help in reducing caesarean rates worldwide if tackled by proper decision making and vigilant observation. Present study is intended to review the research publications surrounding VBAC-2. Search was carried out for gathering research publications up to April 2024 by using the keywords of "Vaginal birth after two or more caesarean sections", "trial of labour after two or more caesarean section", "VBAC-2", or "TOLAC-2". 51 relevant publications were considered in present study. Success rates of VBAC-2 studies were calculated as 70.83% for the study population. Furthermore, uterine rupture, blood transfusion, hysterectomy, maternal and neonatal outcomes were analysed after VBAC-2. Besides these, 14 case studies were analysed separately. Results indicate that VBAC-2 is safe, but careful patient selection and vigilant monitoring of indications is necessary for decision making. Information gathered and analysed will help in making evidence centred decisions in such cases.

Ectopic pregnancies at a tertiary care centre: a five-year retrospective study

Background: Ectopic Pregnancy results in significant morbidity. Our aim during present study was to understand age wise, parity wise distribution of cases, risk factors, clinical presentation and management of ectopic pregnancy which may be useful in lowering morbidity and mortality.Methods: A five-year retrospective study was done from 2019 to 2023; comprising detailed medical records of detected cases of ectopic pregnancies admitted to the tertiary care centre.Results: Incidence of ectopic pregnancy during present study was 0.40%. 65.48% of ectopic pregnancy cases recorded in the age group of 21-30 years. Majority of parity wise cases were multipara (63.95%). There were no risk factors noted in 34.01% cases. Majority of the cases (65.95%) had one or the other distinguishable risk factor. 21.68% cases had history of Tubectomy, while 19.38% ectopic gestation had history of abortion. Most of the patients presented with clinical presentation of amenorrhoea 59.89%. 55.83% cases had bleeding per vaginum, while 47.71% had pain in abdomen. Most common ectopic pregnancy site was ampulla, with 63.95% cases. Ultrasonic findings showed ruptured ectopic pregnancy in 59.39% cases and unruptured in 30.45%. Regarding mode of management in the cases, surgical management with unilateral total salpingectomy (56.79%) was most commonly performed, followed by salpingoopherectomy (14.81%).Conclusions: Ectopic pregnancy is a common obstetric emergency leading to first trimester morbidity and mortality. Diagnosis of these cases requires a high index of clinical suspicion and early intervention often is lifesaving. Hence, knowledge of the disease related trends and timely management is the key for successful outcomes in such cases.

Severe immune thrombocytopenia in pregnancy: a case report

Pregnancy when complicated with severe immune thrombocytopenia is a challenge both during labour and peripartum period. It’s management requires a multidisciplinary care approach. Severity of ITP may have adverse consequences on both maternal and fetal outcome. Present case report is of a patient with findings of chronic thrombocytopenia who came to antenatal outpatient department at 28 years of age with 7 months of amenorrhea with history of bleeding gums and purpura. She was monitored throughout third trimester of pregnancy. Ultrasonography findings showed severe oligohydramnios at 38 weeks and based on obstetric indications, elective cesarean section was planned after consultation with anesthetist and hematologist. Patient landed in intraoperative postpartum hemorrhage and was managed with medical management along with glove balloon tamponade. Patient was discharged on day 10 day along with her newborn. It shows that close monitoring of the clinical course and multidisciplinary care is critical to reach the correct treatment implication as well as potential management of such cases.

Vaginal birth after multiple caesarean section: a case report from India

Lower segment caesarean sections increase the possibility of maternal morbidity. Hence, since last few decades, initiative for trial of labor after caesarean delivery is being encouraged in selected cases. Accordingly, a 23-year-old fifth gravida, who had a history of previous three lower segment caesarean sections and one vaginal birth approached for delivery service and plan for her vaginal delivery was made after thorough examination and evaluation. A live female child of 3100 grams was delivered following episiotomy. In post-partum period, it was observed that uterus was involuted on abdominal examination and uterine contours were regular in ultrasonography. As the evidences for practice of vaginal delivery in women who underwent 2 or more previous LSCS are still fewer, this report intends to highlight the possibility of successful vaginal birth after multiple caesarean sections.